Dementia, depression and subsequent institutionalization—the effect of home support

Lindsey, James M.; Murphy, Elaine

doi:10.1002/gps.930040104

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…This is similar to the findings of the Guy's Age Concern project (Askham et al, 1989;Lindesay and Murphy 1989), where aggression was found to be the most difficult problem to overcome. The subjective burden of the carer is likely to be an important factor influencing the assessment and final allocation (Gillhooly and Whittick, 1989;Morris et al, 1989) and the absence of such measures is a major limitation of the study, although it is interesting that irritable temperament and assistance with physical aspects of self-care two of the factors most poorly tolerated by carers (O'Connor et al, 1990), were significantly different between the two groups.…”

Section: Discussionsupporting

confidence: 90%

“…It is interesting that despite similar dependency levels and cognitive impairment in the two groups, the outcome was much poorer for those allocated to inpatient assessment, suggesting that irritability, restlessness, physical illness and the need for assistance for self-care were major factors in determining whether relatives or professional carers were considered to be capable of looking after a particular patient. This is similar to the findings of the Guy's Age Concern project (Askham et al, 1989;Lindesay and Murphy 1989), where aggression was found to be the most difficult problem to overcome. The subjective burden of the carer is likely to be an important factor influencing the assessment and final allocation (Gillhooly and Whittick, 1989;Morris et al, 1989) and the absence of such measures is a major limitation of the study, although it is interesting that irritable temperament and assistance with physical aspects of self-care two of the factors most poorly tolerated by carers (O'Connor et al, 1990), were significantly different between the two groups.…”

Section: Discussionsupporting

confidence: 89%

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The rationale of patient allocation for psychogeriatric assessment

Handy

Chithiramohan

Ballard

et al. 1991

Int J Geriat Psychiatry

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SUMMARYOur review of 100 patients using the Camdex and Crichton assessment schedules shows that the severity of illness and degree of dependency are similar in day hospital and inpatient assessment groups. The main predictors of allocation for inpatient assessment and eventual placement in long-stay geriatric wards were restlessness, irritability, the need for assistance with self-care and physical illness. More planning and resources need to be mobilized in the assessment of dementia patients and the treatment of problem behaviours.KEY WORDS-Psychogeriatric assessment, inpatient, day patient.Most psychiatric services offer day hospital and inpatient assessment facilities for the elderly with organic impairment but there is very little written about the rationale for patient allocation. We evaluate the characteristics of day patient and inpatient assessment groups, investigate the variables which appear to influence patient allocation and discuss alternatives to the current assessment procedures. SERVICE CONTEXTThe Department of Psychogeriatrics in Coventry serves a population of 300 000. It has a 20-bedded inpatient assessment unit with facilities for night relief and respite care admissions, a day hospital with 25 places for assessment and treatment, a 28-bedded inpatient unit for functional mental illness in the elderly, three medium dependency wards with 51 beds, one high dependency unit with 25 beds, onsite outpatient facilities and an active multidisciplinary community support team for the elderly.Coventry has a wide range of community facilities for the elderly, with social services, voluntary and private provisions which include day centres, luncheon club, semi-sheltered accommodation, sheltered accommodation, rest homes, part I11 homes and private nursing homes.Correspondence to Dr S. Handy. METHODFifty consecutive psychogeriatric day hospital assessment patients and 50 consecutive inpatients for assessment were evaluated using the Camdex interview schedule (Roth et al., 1986) conducted after one week of assessment and Crichton schedule (Robinson, 1961) evaluated over a one-month period. The information was collected to compare type and severity of dementia, relative support, physical health, accommodation prior to admission, overall dependency, the degree of assistance needed for self-care, continence, sleep, mobility and temperament between the two groups. The diagnosis and categorization of the severity of dementia were made according to the Camdex criteria. RESULTSSixty per cent of the day hospital patients were male. The average age was 75.96 years compared to an average age of 75.82 years among the inpatient assessment group, of whom 46% were male. Seventy per cent of the day hospital patients had a diagnosis of senile dementia of Alzheimer's type (SDAT), 12% had a diagnosis of vascular dementia (VD), 16% had both SDAT and VD, and only 2% received other diagnoses. Similarly, 66% of the inpatients group had a diagnosis of SDAT, 24% had VD, 6% both SDAT and VD, and 4% received

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

The rationale of patient allocation for psychogeriatric assessment

Handy

Chithiramohan

Ballard

et al. 1991

Int J Geriat Psychiatry

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show abstract

“…The prevalence of depression in elderly medical inpatients is over 20% (O'Riordan et al, 1989;Burn et al, 1993;Hammond et al, 1993), approximately twice that found in the community (Copeland et al, 1987;Lindesay and Murphy, 1989). The prevalence of physical problems is highÐover 80% of people aged 70 years or more suer from a signi®cant (i.e.…”

mentioning

confidence: 99%

Placebo-controlled treatment trial of depression in elderly physically ill patients

Evans

Hammond

Wilson

et al. 1997

Int. J. Geriat. Psychiatry

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“…Day hospital attenders exhibited more severe cognitive impairment on the MMSE, and while they showed greater deficits on the apathy and communication subscales of the CAPE, their overall level of behavioural disturbance was no greater than for day centre attenders. Aggression, irritability and the need for physical assistance with self-care are factors which have been found to impose significant strain on carers of the demented elderly (Askham and Barker, 1989;Lindesay and Murphy, 1989;O'Connor et ul., 1990). These behaviours are included in the social disability and physical disability subscales of the CAPE, and scores thereon did not differ between the two groups.…”

Section: Discussionmentioning

confidence: 98%